October 04, 2006

Andrea Leadsom: Are we getting value for money from the NHS?

The question was asked of Andrew Lansley, Shadow Minister for Health, Anna Walker Chief Exec of the Healthcare Commission and Beverley Malone, Gen Sec of the Royal College of Nursing.

It was interesting that the three panellists all welcome the enormous increases in spending on the NHS, and feel there is more to be done. Andrew Lansley pointed out we are still behind France and Germany in spending on health.

Beverley Malone made a plea for more involvement from nurses in the strategic planning for the NHS to ensure better value for money and less waste. She gave an example of a new PFI hospital that was built without consultation with nurses. Once the corridors were put in, it was apparent they were too narrow to turn around a trolley bed……

Anna Walker made a strong case for good value being achieved. Waiting lists are shorter, treatment in some areas like heart disease, cancer and strokes have improved dramatically, the focus on ‘health’ rather than ‘healthcare’ is starting to pay dividends in the focus on obesity and smoking.

Anna also talked, however, about where the HC has concerns – the ‘Cinderella services’ such as mental health, learning disabilities, older people and children. In all of these, there is much more to be done. Also, she is concerned that patient safety needs to be more at the heart of NHS culture.

Andrew Lansley praised the improvements made in waiting times, but pointed out that these are in England – in Wales, Scotland and Northern Ireland waiting times remain unacceptable. The Office of National Statistics has confirmed a fall in productivity growth – in other words, the doubling of cash for the NHS has not resulted in commensurate productivity.

Andrew is optimistic about the future for the NHS however. He thinks the culture has permanently changed for the better as a result of the introduction of performance measures. He talked about a Matron at Kettering hospital who was able to articulate the restructuring of A&E to meet the 4 hour target. This was a real ‘patient-centred’ initiative.

The panellists agreed that putting patients at the heart of the NHS is critical. Listening to what patients want, not just in terms of treatment, but also in terms of the structure of their NHS, is important. The question of ‘specialisation’ versus ‘access to services’ is a big one and deserves much broader public consultation.

The answer to the question, ‘Is the NHS delivering value for money?’ ended up, I would say, as ‘on balance, not yet’.